Interventions to modify sexual risk behaviours for preventing HIV in homeless youth

Abstract

Background Homeless youth are at high risk for HIV infection as a consequence of risky sexual behavior. Interventions in homeless youth are challenging. Assessment of the effectiveness of interventions to modify sexual risk behaviours for preventing HIV in homeless youth is needed. Objectives To evaluate and summarize the effectiveness of interventions for modifying sexual risk behaviours and preventing transmission of HIV among homeless youth. Search methods We searched electronic databases (CENTRAL, Medline, EMBASE, AIDSearch, Gateway, PsycInfo, LILACS), reference lists of eligible articles, international health agency publication lists, and clinical trial registries. The search was updated January 2010. We contacted authors of published reports and other key role players. Selection criteria Randomized studies of interventions to modify sexual risk behavior (biological, self-report sexual-risk behavior or health seeking behavior) in homeless youth (12–24 years). Data collection and analysis Data from eligible studies were extracted by two reviewers. We assessed risk of bias per the Cochrane Collaborations tool. None of the eligible studies reported any primary biological outcomes for this review and the reporting of self-report sexual risk behavior outcomes was highly variable across studies precluding calculation of summary measures of effect; we present the outcomes descriptively for each study. We contacted authors for missing or ambiguous data. Results We identified three eligible studies after screening a total of 255 unique records. All three were performed in the United States of America and recruited substance-abusing male and female adolescents (total N=615) through homeless shelters into randomised controlled trials of independent and non-overlapping behavioural interventions. The three trials differed in theoretical background, delivery method, dosage (number of sessions,) content and outcome assessments. Overall, the variability in delivery and outcomes precluded estimation of summary of effect measures. We assessed the risk of bias to be high for each of the studies. Whilst some effect of the interventions on outcome measures were reported, heterogeneity and lack of robustness in these studies necessitate caution in interpreting the effectiveness of these interventions. Authors’ conclusions The body of evidence does not permit conclusions on the impact of interventions to modify sexual risk behaviour in homeless youth. More research is required. While the psychosocial and contextual factors that fuel sexual risk behaviours among homeless youth challenge stringent methodologies of RCT’s, novel ways for program delivery and trial retention are in need of development. Future trials should endeavour to comply with rigorous methodology in design, delivery, outcome measurement and reporting.

Reducing high risk behaviors among street living youth: Outcomes of an integrated prevention intervention

“…Less clarity is available on how best to intervene in these high risk behaviors. HIV prevention interventions targeting homeless youth are challenging to implement and only a limited number of studies report some success (Naranbhai, Abdool, & Meyer-Weitz, 2011). Contributing to this small body of literature, the current study examines HIV risk behavior outcomes for an integrated HIV risk prevention intervention tested with substance use disordered street living youth between the ages of 14 to 20 years.…”

Psychiatric Disorders, High-Risk Behaviors, and Chronicity of Episodes Among Predominantly African American Homeless Chicago Youth

“…3,13 Consistent homelessness for six months or longer has also been associated with more HIV-risk behaviors, 14 which is unsurprising in light of homeless youth’s overall higher likelihood of multiple sexual partners and greater risk of STIs compared with national norms. 4,15,16 HIV/AIDS prevalence among U.S. homeless and runaway youth is estimated to be up to 11.5%. 17,18 Nonetheless, some studies have failed to find a correlation between length of homelessness and sexual risk behaviors, 15 indicating a need for further research.…”

Predicting Sexual Behaviors Among Homeless Young Adults: Ecological Momentary Assessment Study

“…For decades, prevention research has been challenged by the unsubstantiated belief that homeless youth are beyond help [ 14 ]. Prevention interventions specifically targeting homeless youth, though rare, have achieved marginal and temporary improvements in sexual health outcomes (eg, decreased frequency of condomless sex in females) and have been limited to substance-using samples [ 4 , 15 - 18 ]. However, even modest intervention effects in a marginalized understudied, high-risk population moves the science forward [ 19 ].…”